Most cocaine in U.S. cut with dangerous livestock drug

Illicit revelers beware: There is no pure cocaine in San Francisco, or in most of America. Nearly all of the cocaine coming into the United States at present has been cut with a veterinary drug called Levamisole that is used to deworm livestock, and can bring on severe illness and death in humans, say public health experts.

Officials with the U.S. Centers for Disease Control and Prevention first began to warn health officials of risks from levamisole in cocaine in September.

In December, the CDC released a report noting that 69 percent of cocaine recently seized in the United States had been tainted with levamisole, and illness from exposure to the drug has been found in at least four states.

Levamisole can cause a crash in the body’s white blood cell count, a condition called agranulocytosis. Symptoms include fever, glandular swelling, painful sores in the mouth and anus, and a very stubborn infection.

The illness was discovered when Dermatologists at S.F. General found and treated two patients with the condition. In San Francisco, patients with levamisole poisoning also suffer serious skin conditions that make their skin look black and slough off.

Doctors and lab specialists at S.F. General are leading state and national efforts to diagnose and treat patients. So far, doctors have confirmed eight cases of illness from levamisole at two hospitals in San Francisco.

After doctors realized that all of the patients were cocaine users, they began to test other cocaine-positive patients for levamisole. In October alone, they discovered about 180 out of 200 of them also had levamisole in their system.

All of the cases in San Francisco involved women who used either crack or powder cocaine. At San Francisco General Hospital, where the first cases of the illness were diagnosed, 90 percent of 200 patients who recently tested positive for cocaine also tested positive for levamisole. Most of them did not become ill.

“The big question we have right now is, if 90 percent of cocaine users in San Francisco are positive for levamisole and are being exposed to this compound, then why aren’t 90 percent of them in the emergency room with these side effects?” said Kara Lynch, associate chief of the chemistry and toxicology lab at S.F. General.

Doctors suspect that the answer lies in the immune systems of the patients. Some patients with compromised immune systems may be more susceptible to the illness, or simply the canary in the coalmine.

The eight people San Franciscans sickened by levamisole survived, but at least one death has been reported in New Mexico, according to the CDC, and more reports of strange, cocaine-related illnesses are trickling in from other states.

Because many of the symptoms of the illness mimic the flu, officials urge providers to be aware that more testing may be necessary to make sure cocaine users aren’t in fact sick with something far worse than influenza.

Dr. Jonathan Graf, an assistant professor in rheumatology at S.F. General who works with the Rosalind Russell Arthritis Research Center at UCSF, said doctors are mystified as to why San Francisco patients are getting the condition that blackens their skin and makes it appear to be “sloughing” off, while patients in other areas are not.

“I have a feeling this is out there a lot more than we’re giving it credit for,” Graf said. “There are probably many cases of this going on around the Bay Area and elsewhere. There are probably a lot of people not coming in to emergency rooms or doctors.”

Doctors fear that aspects of the illness are still being discovered, and as more doctors and public health officials become aware of the problem, more cases, along with more symptoms, will be emerge, he said.

“We need people to know that you’re not getting pure cocaine anymore. You’re exposing yourself to the effects of an anti-parasite drug instead of cocaine,” said Dr. H. Westley Clark, director of substance abuse treatment with the U.S. Substance Abuse and Mental Health Services Administration. “You’re not getting high off of cocaine, you’re getting sick off of levamisole.”